National Care Service failure – public ownership essential

Chris Sermanni, Glasgow City Unison convener (personal capacity)

In September 2020, the SNP Scottish government announced plans for the establishment of a National Care Service (NCS) in Scotland. At this point in time, the country was still in the middle of the COVID-19 pandemic. 

Criticism of how the Scottish Government had handled the early days of the pandemic, particularly around hospital discharges, had stung the SNP and the announcement was seen as a response to this. 

Nicola Sturgeon said that the pandemic has “underlined the need for improvement and reform” of the care sector, and it was clear from this announcement that the SNP wanted the creation of the NCS to be viewed as a significant legacy of their time in charge of the Scottish Government. 

The rhetoric sought to draw comparisons with the creation of the National Health Service in the post war period; Sturgeon drew parallels between the tragedy of the second world war, and the still unfolding pandemic. 

She was right to highlight the inadequacy of the care sector in Scotland, much of it run for profit by private companies or individuals, where extremely low pay, and poor terms and conditions are the norm across the country. 

Consequently, the announcement was met with broad acceptance, both politically and publicly, though the question remained as to what the SNP’s vision of an NCS would look like in reality.

The government brought forward their bill for the NCS in June 2022 following a lengthy consultation process, labelling it “the most ambitious reform of public services since the creation of the NHS”.

ownership neutral 

It was immediately clear, however, that their vision of the NCS falls far short of Nye Bevan’s vision for NHS. Some of the work around the bill was undertaken by Price Waterhouse Cooper, a multinational corporation, and far from eliminating profit from care, it enshrines the role of the private sector. 

The Scottish Government termed their position as ‘ownership neutral’, paving the way for continued exploitation of workers, and those who pay for services. Their NCS would be underpinned by the market: 

“The current models of securing care services will be replaced by a model of ethical commissioning and ethical procurement as the cornerstone of the National Care Service”. 

This commitment to commissioning and procurement of services from the market was compounded by an attack on local democracy. 

The bill allows for the transfer of local authority functions, staff and property to unelected boards that will replace the current IJBs. These board will have direct ministerial accountability, and relegates councils to the role of contractors. 

The bill strongly implies that local authorities could compete for contracts to deliver social care services. 

Care workers in local authorities have benefitted from the presence of trade unions, and established collective bargaining structures, meaning that pay is generally higher, and terms and conditions are stronger – a national care service wedded to the principles of commissioning and procurement will seek value, and threatens to drive standards of pay down. 

The bill fails to make provision for sectoral collective bargaining, which would be crucial component in helping to protect gains made, and drive up chronic low pay in other parts of the care sector.

No commitments have been made or clarity given on pensions, and the law offers very little protection for pensions in the event of TUPE transfer. 

Fundamentally, the bill fails to address any of systemic issues that have plagued the care sector for years. It does nothing to address the exploitation of workers and those who need care services. 

Condemnation of the bill has been almost unanimous; it’s hard to find an organisation that is supportive of it in its current form.

The key public sector trade unions have been scathing of it, with UNITE recently withdrawing from “any forthcoming involvement in the co-design of this alleged National Care Service” and UNISON describing it as “a shambles”. 

COSLA, Social Work Scotland, and BASWA have also condemned the plans. This has led to widespread calls for the government to ‘pause’ the bill, whilst more calls have been made for them to withdraw it and start again.

Despite the sustained criticism, the SNP appear keen to press on with the bill, and have rejected calls to pause or withdraw the legislation. 

Kevin Stewart, Minister for Social Care, incredibly claims that the development of the NCS is on track, despite almost unanimous opposition, and warnings from the Scottish Government’s Finance and Public Administration Committee that the costings simply don’t add up. 

Their ‘Report on the financial memorandum for the National Care Service Bill’ concluded: 

“The Committee has significant concerns in relation to the costings within this Financial Memorandum, which it considers does not provide best estimates of the costs the Bill gives rise to.” 

“The current Financial Memorandum relies heavily on future secondary legislation and business cases and does not provide the Committee with enough detail on costs to allow it to fully assess or scrutinise the financial implications of the Bill”

The final point referring to secondary legislation is in effect a call from the Scottish Government to those with concerns to ‘trust us’, as their position is that they will provide the fine detail of how the NCS will look in a series of subsequent legislation, once the current bill is passed. 

Despite lacklustre claims to be listening to criticism, the official line from the government is that all is well, and appear determined to create a body that enshrines private enterprise within the care sector.

The SNP vision for a National Care Service is doomed to failure, and addresses none of the issues that Thatcher’s privatisation policies embedded in social care sector in the 1980s.

public ownership

Scotland needs a national care service that is publicly owned, worker and community controlled, appropriately funded, and one that nationalises private care providers that profit from the sector. 

Care should be provided on a needs basis, not on ability to pay. 

A £15 per hour minimum wage would go some way to tackling the chronically low pay in care services, and a commitment to sectoral collective bargaining. 

These are the key issues that the trade unions should be fighting for in the months ahead. 

The profit system of capitalism is incapable of providing care for those who need it. In a socialist society all aspects of health, care and social support would be fully funded and planned in the interests of the majority.